Application for Authority to Employ Six or Fewer Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture

Under Regulations 29 CFR Part 519
Note:

U. S. Department of Labor Employment Standards Administration Wage and Hour Division 230 South Dearborn, Room 514 Chicago, Illinois 60604-1757

Persons are not required to respond to this collection of information unless it displays a currently valid OMB ⏐ OMB No.: 1215-0032 control number. ⏐ Expires: 11/30/2008 This is an application for retail or service establishments or agricultural employers to obtain authority to employ up to six full-time students at subminimum wage rates on any workday under Section 14(b) of the Fair Labor Standards Act (FLSA). The subminimum rates paid full-time students under Section 14(b) may not be less than 85 percent of the applicable minimum wage under Section 6 of the FLSA. The term “employer” as used by this application means the highest structure of ownership or control and hence, may be more than one establishment or farm, i.e., the controlling conglomerate or enterprise would be the “employer.” Thus, the limit of six full-time students applies to the “employer” and not to each establishment or farm in the enterprise or business. Those seeking to employ more than six full-time students at subminimum wages throughout a single enterprise or business should complete and submit WH Form 200 (Application for Authority to Employ Full-Time Students at Subminimum Wages in Retail or Service Establishments or Agriculture). Temporary authority to employ full-time students at subminimum wages is effective when this form is properly completed and forwarded to the address listed above. This temporary authority may be effective for a period of up to one year, provided that within 30 days of the forwarding, the Administrator of the Wage and Hour Division does not deny the application, issue a certificate with modified terms or conditions, or expressly extend the 30-day period of review. See reverse for more information about temporary authority. Please submit one copy of the completed form to the address shown above. Retain a completed copy for your records. A certificate may not be granted unless a properly completed application has been received and approved.
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1.

This is (check one): Initial Application Renewal Application (complete following): Current Certificate Number: ________________ Certificate Expiration Date: _____/_____/_____
Pending Withdrawn

FOR USDOL USE ONLY Denied Revoked RO ________ DO ________ Issued Issue/W Pending

Postmark Date: ___/____/____ Print Cert. Effective _____/_____/_____

New Cert No. Expiration

__________________

_____/_____/_____

Total number of full-time students paid subminimum wages during the most recent 12 months: _______ __________________________________________________ 2. Name of Employer: ____________________________ ____________________________ Street Address: ______________________________ State: _____ ) Zip: _______

Remarks: ______________________________________________________ _________________________________________________________________ _________________________________________________________________

4.

City: _______________ Telephone No.: (

If full-time students will be employed at subminimum wages at establishments other than that listed in block 2, provide the names and addresses of those establishments:
1. 2. ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________

Will you employ full-time students at the above location at subminimum wages?

Yes

No

3. 4.
5.

Mailing Address (if different than street address): ____________________ City: _______________ State: _____ Zip: _______

Federal Employer Identification Number (EIN): ____________________ 3. Type of establishment(s) where full-time students will be employed at subminimum wages (check all that apply) and provide names and addresses of each establishment in block 4): Grocery Store Full Service Restaurant Convenience Store Fast Food Restaurant Clothing/Shoe Store Hotel/Motel Movie/Theater General Merchandise Hospital/Nursing Home Other Retail/Service, Specify Type: _____________ Agriculture, Specify Crop/Product ____________ Representations, certification and signature: I certify, as set forth in Regulations, 29 CFR Part 519, Subpart B, that the employment of not more than six full-time students on any workday will not reduce the full-time employment opportunities of other workers.
6. Authorized representative (print or type) 8. Title (print or type) 7. Signature of authorized representative: 9. Date application forwarded to USDOL:

5.

Public Burden Statement This collection of information is estimated to vary from 15 to 30 minutes per response with an average of 23 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have any comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, send them to the U. S. Department of Labor, Wage and Hour Division, Room S-3502, 200 Constitution Avenue, N.W., Washington, D.C., 20210 (do not send the completed application to this address). Form WH-202 Rev. Oct. 2002

TEMPORARY NOTICE TO EMPLOYEES
THE EMPLOYER NAMED BELOW HAS FILED AN APPLICATION WITH THE WAGE AND HOUR DIVISION FOR AUTHORITY TO EMPLOY UP TO SIX FULL-TIME STUDENTS ON ANY WORKDAY AT THE ESTABLISHMENT(S) LISTED AT A WAGE RATE NOT LESS THAN 85% OF THE STATUTORY MINIMUM ESTABLISHED UNDER SECTION 6 OF THE FAIR LABOR STANDARDS ACT (THE FEDERAL WAGE AND HOUR LAW). THIS AUTHORITY IS EFFECTIVE FROM THE DATE THE APPLICATION IS MAILED (POSTMARKED) TO THE DIVISION AND MAY REMAIN IN EFFECT FOR A PERIOD OF ONE YEAR. Name of Employer: ____________________________________________________________ Name and Address of Establishment(s) Where Full-Time Students May Be Employed At Subminimum Wages Under This Temporary Notice:
1. ________________________________________ ________________________________________ ________________________________________ 2. ________________________________________ ________________________________________ ________________________________________ 3. ________________________________________ ________________________________________ ________________________________________ 4. _______________________________________ _______________________________________ _______________________________________ 5. _______________________________________ _______________________________________ _______________________________________ 6. _______________________________________ _______________________________________ _______________________________________

Date application was mailed to the Division:

____/____/____

Full-time students may be employed under the terms of this authority only outside of their scheduled hours of instruction and for not more than 8 hours a day or more than 20 hours a week when school is in session all week or more than 40 hours a week during the student’s vacation. Full-time students must be employed in compliance with local ordinances, State laws, and other Federal laws, including child labor provisions. There is no authority to pay subminimum wages to full-time students for work under the Walsh-Healey Public Contracts Act or the Service Contract Act. This temporary authority may only be issued if the follow conditions are met (29 CFR Part 519.5):

a. The granting of the authority requested is necessary to prevent curtailment of opportunities for employment; b. The employment of full-time students at subminimum wages will not create a substantial probability of reducing the full-time employment opportunities of other persons; c. Full-time students are available for employment at subminimum wages; d. Abnormal labor conditions, such as a strike or lockout, do not exist in the establishment(s) for which authority is sought; e. There are no serious outstanding violations of the provisions of the previous authority to employ full-time students nor of other provisions of the Fair Labor Standards Act; f. The granting of the authority will not result in a reduction of a wage rate paid to a current employee, including student employees.

Any interested person may send data or views concerning the application to the Wage and Hour Division, 230 South Dearborn, Room 514, Chicago, Illinois 60604-1757.

TO THE EMPLOYER: It is required that you complete this notice and post it in a conspicuous place at each establishment where full-time students will be employed from the date the application is mailed to the Division and that it remain posted during the effective period of the temporary authority.
Form WH-202 Rev. Oct. 2002